Endometriosis is a condition that occurs when the membrane lining the uterus — the endometrium — develops outside the uterus.
During a normal menstrual cycle, the endometrium thickens in preparation for a potential pregnancy. If no pregnancy occurs, cells in the endometrium break down and bleed from the body. If the endometrium develops in places other than the lining of the uterus, the cells cannot safely leave the body. This may result in swelling, pain, and internal scarring.
There is no cure for endometriosis, but there are a number of treatments that mainly focus on the relief of symptoms. Surgical options might help improve a patient’s well-being, but always involve risk and are only recommended in cases of severe pain. Hysterectomy is a type of surgery performed only in extreme cases.
What is a hysterectomy?
A hysterectomy is the removal of the uterus. It is irreversible; women cannot become pregnant after this surgery.
It is necessary to remove all endometriosis tissue with the hysterectomy. Otherwise, the symptoms will persist.
There are two types of hysterectomies, total and subtotal. In a total hysterectomy, the uterus and the cervix are removed; in a subtotal hysterectomy, the cervix is left intact.
One or both ovaries may also be removed along with the uterus. This is called oophorectomy.
Methods of hysterectomy
There are three ways to perform a hysterectomy: abdominally, vaginally, and laparoscopically.
In an abdominal hysterectomy, the uterus is removed through an incision made on the lower abdominal wall. Recovery takes longer than the other methods. The procedure allows the removal of endometrial tissue at the same time.
In a vaginal hysterectomy, an incision is made around the cervix at the top of the vagina, and the uterus and cervix are removed through the incision. This method is less invasive than an abdominal hysterectomy and the recovery time is shorter. It is, however, more challenging to remove endometrial lesions with this procedure.
In a laparoscopic hysterectomy, a small incision is made through which a laparoscope, a thin viewing tube similar to a telescope, is placed into the abdomen. Because this method requires only small incisions, the recovery is faster than with an abdominal hysterectomy. A laparoscopic hysterectomy also allows for the removal of endometrial lesions.
Risks and consequences of hysterectomy
As soon as menstrual periods stop, estrogen levels go down, and endometriosis symptoms might improve by themselves, so it might not be worth taking the risks associated with a hysterectomy if a woman is close to entering menopause.
If menopause is still years away and the symptoms of endometriosis are severe and not responsive to other treatments, a hysterectomy might be considered. Women who make this decision must be aware that the removal of the uterus is irreversible and they will be unable to have children.
Hysterectomy is a major operation, and comes with the risk of complications. There is a small risk of heavy bleeding after the surgery and a chance of infection. In rare cases, the ureter (the tube that urine passes through), the bladder, or the bowel may be damaged.
If the ovaries are removed with the uterus, this will result in immediate menopause. If the ovaries are left intact, there is a chance that menopause will occur within five years after the surgery.
Research has shown that hysterectomy may be associated with an increased risk of cardiovascular disease.
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